TY 2013 Form 990

(A) Name and business address	(B) Description of services	(C) Compensation
LINBECK GROUP LLC, 201 MAIN STREET STE 1801FORT WORTHTX76102	CONSTR CONTRACTOR	16,819,397
MEDTRONIC, PO BOX 848086DALLASTX752848086	MED SUPPLY SERVICES	3,295,946
PROGRESSIVE PARKING SOLUTIONS, 201 W BROADWAY SUITE G-5N LITTLE ROCKAR72114	PARKING SERVICES	781,911
MAQUET CARDIOVASCULAR US SALES, 3615 SOLUTIONS CENTERCHICAGOIL606773006	MED SUPPLY SERVICES	776,343
DUNAWAY ASSOCIATES LP, 550 BAILEY AVE STE 400FORT WORTHTX76107	CONSTR CONTRACTOR	704,913
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 14

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	50,960,970	50,960,970
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	172,865	172,865
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	2,775,730		2,775,730
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	220,648,665	198,549,005	22,099,660
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	0
9	Other employee benefits .......	74,774,750	67,259,175	7,515,575
10	Payroll taxes ...........	0
11	Fees for services (non-employees):
a	Management ......	118,804,857	4,622,772	114,182,085
b	Legal .........	111,157		111,157
c	Accounting ...........	0
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	20,763,577	15,380,468	5,383,109
12	Advertising and promotion ....	97,674	71,724	25,950
13	Office expenses .......	75,494,210	73,183,100	2,311,110
14	Information technology ......	0
15	Royalties ..	0
16	Occupancy ...........	5,795,085	4,425,297	1,369,788
17	Travel ............	1,239,950	1,087,394	152,556
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	528,483	394,261	134,222
20	Interest ...........	13,194,972	13,114,235	80,737
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	34,934,423	25,432,026	9,502,397
23	Insurance ..............	1,869,250	1,869,250
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	PHYSICIAN REMUNERATION	8,196,792	6,681,316	1,515,476
b	BAD DEBT EXPENSE	22,469,045	22,469,045
c	MINOR EQUIPMENT	4,933,893	1,563,191	3,370,702
d	REPAIRS & MAINTENANCE	5,803,726	2,144,855	3,658,871
e	All other expenses	12,169,750	9,073,306	3,096,444
25	Total functional expenses. Add lines 1 through 24e	675,739,824	498,454,255	177,285,569	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............	12,260	1	12,995
2	Savings and temporary cash investments .........	269,263,512	2	373,121,277
3	Pledges and grants receivable, net ...........	0	3	0
4	Accounts receivable, net .............	74,744,066	4	80,026,528
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
		0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
		0	6	0
7	Notes and loans receivable, net .............	18,870,960	7	24,219,660
8	Inventories for sale or use ..............	6,927,758	8	7,588,405
9	Prepaid expenses and deferred charges ..........	838,931	9	272,583
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	788,518,922
b	Less: accumulated depreciation .....	10b	289,577,801	436,783,028	10c	498,941,121
11	Investments—publicly traded securities ..........	8,009,418	11	182,340,486
12	Investments—other securities. See Part IV, line 11 .....	0	12	0
13	Investments—program-related. See Part IV, line 11 .....	0	13	0
14	Intangible assets ...............	7,424,990	14	7,424,990
15	Other assets. See Part IV, line 11 ...........	31,624,682	15	43,790,840
16	Total assets. Add lines 1 through 15 (must equal line 34)......	854,499,605	16	1,217,738,885
	17	Accounts payable and accrued expenses .........	63,700,555	17	86,961,995
18	Grants payable .................	0	18	0
19	Deferred revenue ................	6,832	19	15,982
20	Tax-exempt bond liabilities .............	295,407,851	20	467,295,766
21	Escrow or custodial account liability. Complete Part IV of Schedule D..	0	21	0
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ....	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................	24,014,190	25	4,695,616
26	Total liabilities. Add lines 17 through 25.........	383,129,428	26	558,969,359
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	471,370,177	27	658,769,526
28	Temporarily restricted net assets ...........	0	28	0
29	Permanently restricted net assets ...........	0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	471,370,177	33	658,769,526
34	Total liabilities and net assets/fund balances ........	854,499,605	34	1,217,738,885

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.
right arrow

Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization

Cook Children's Medical Center

Employer identification number

75-2051646

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Non-functionally integrated

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the supported organization? ................

11g(i)

(ii) A family member of a person described in (i) above? ......................

11g(ii)

(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of monetary support
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of monetary support


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2013

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here................................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2012 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2013. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2012. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2013. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2012. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2013

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2012 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2012 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2013. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ........ right arrow

33 1/3% support tests—2012. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2013

Page 4

Part IV

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2013

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Name of the organization

Cook Children's Medical Center

Employer identification number

75-2051646

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year ......................... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 2

Name of organization Cook Children's Medical Center

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTEDRESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 3

Name of organization Cook Children's Medical Center

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 4

Name of organization
Cook Children's Medical Center

Employer identification number

75-2051646

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed.

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions. SchDMd Bullet

Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

Cook Children's Medical Center

Employer identification number

75-2051646

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) .....
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2013

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....	56,839,390	90,534,565	82,538,362	80,357,260	70,947,601
b	Contributions ........	336,613	29,553	-256,157	18,935	3,803,664
c	Net investment earnings, gains, and losses	5,450,280	9,201,059	8,800,000	2,595,270	5,976,642
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........	603,585	42,925,787	547,640	433,103	370,647
f	Administrative expenses ....
g	End of year balance ......	62,022,698	56,839,390	90,534,565	82,538,362	80,357,260

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

23.000 %

Permanent endowment SchDMd Bullet

74.000 %

Temporarily restricted endowment SchDMd Bullet

3.000 %

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

Yes

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	13,464,223		13,464,223
b	Buildings ................	513,395,879	164,015,909	349,379,970
c	Leasehold improvements ............	3,923,080	3,075,868	847,212
d	Equipment ................	171,159,511	117,886,857	53,272,654
e	Other .................	86,576,230	4,599,167	81,977,063
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				498,941,122

Schedule D (Form 990) 2013

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes		0
EST. PAYABLE (THIRD PARTY)		4,822,016
DUE TO/FROM AFFILIATES		-126,400







Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		4,695,616
2. Liability for uncertain tax positions In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ..................................................

Schedule D (Form 990) 2013

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	869,416,361
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	15,728,498
e	Add lines 2a through 2d .....................			2e	15,728,498
3	Subtract line 2e from line 1.....................			3	853,687,863
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b	2,621,713
c	Add lines 4a and 4b.......................			4c	2,621,713
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	856,309,576

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	684,437,219
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	31,166,441
e	Add lines 2a through 2d......................			2e	31,166,441
3	Subtract line 2e from line 1.....................			3	653,270,778
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b	22,469,046
c	Add lines 4a and 4b.......................			4c	22,469,046
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	675,739,824

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
SCHEDULE D, PART XI, LINE 2D	RECONCILATION OF AUDITED REVENUE TO FORM 990 REVENUE: JOINT VENTURE REVENUE NOT INCLUDED ON 990 $39,062,288 INTEREST RATE SWAP ADJUSTMENT ($ 715,896) BAD DEBT DEDUCTION FROM REVENUE ($22,469,045) PLANO GAIN ON SALE OF ASSET (IN AUDIT EXP) ($ 1,800) GAIN ON SALE/DISPOSAL OF ASSET (IN AUDIT EXP) ($ 147,049) --------------- TOTAL $15,728,498
SCHEDULE D, PART XI, LINE 4B	RECONCILATION OF AUDITED REVENUE TO FORM 990 REVENUE: CONTRIBUTION FROM HS RECORDED TO NET ASSETS $ 7,973 CONTRIBUTION FROM HF RECORDED TO NET ASSETS $ 4,265,285 RENT EXPENSE ($ 1,651,545) ---------------- TOTAL $ 2,621,713
SCHEDULE D, PART XII, LINE 2D	RECONCILATION OF AUDITED EXPENSE TO FORM 990 EXPENSE: JOINT VENTURE ACCOUNTS NOT INCLUDED ON 990 $39,062,288 MINORITY INTEREST ($ 9,398,543) RENT EXPENSE $ 1,651,545 GAIN ON SALE/DISPOSAL OF ASSET (IN AUDIT EXP) ($ 147,049) PLANO GAIN ON SALE OF ASSET (IN AUDIT EXP) ($ 1,800) -------------- TOTAL $31,166,441
SCHEDULE D, PART V, QUESTION 4	INTENDED USE OF ENDOWMENT FUNDS: COOK CHILDREN'S HAS ADOPTED INVESTMENT AND SPENDING POLICIES FOR ENDOWMENT ASSETS THAT ATTEMPT TO PROVIDE A PREDICTABLE STREAM OF FUNDING TO PROGRAMS AND OTHER ITEMS SUPPORTED BY ITS ENDOWMENT WHILE SEEKING TO MAINTAIN THE PURCHASING POWER OF THE ENDOWMENT. UNDER COOK CHILDREN'S POLICIES, ENDOWMENT ASSETS ARE INVESTED IN A MANNER THAT IS INTENDED TO PRODUCE AN AMOUNT THAT IS EQUAL TO A RETURN HURDLE DEFINED AS THE SPENDING RATE, INFLATION RATE AND THE MANAGEMENT COST OF THE ENDOWMENT ON AN ANNUAL BASIS WHILE ASSUMING A PRUDENT LEVEL OF INVESTMENT RISK. ACTUAL RETURNS IN ANY GIVEN YEAR MAY VARY FROM THIS AMOUNT. TO SATISFY ITS LONG-TERM RATE OF RETURN OBJECTIVES, COOK CHILDREN'S RELIES ON A TOTAL RETURN STRATEGY IN WHICH INVESTMENT RETURNS ARE ACHIEVED THROUGH BOTH CURRENT YIELD (INVESTMENT INCOME SUCH AS DIVIDENDS AND INTEREST) AND CAPITAL APPRECIATION (BOTH REALIZED AND UNREALIZED). COOK CHILDREN'S TARGETS A DIVERSIFIED ASSET ALLOCATION THAT PLACED A GREATER EMPHASIS ON EQUITY-BASED INVESTMENTS TO ACHIEVE ITS LONG-TERM RETURN OBJECTIVES WITHIN PRUDENT RISK CONSTRAINTS. COOK CHILDREN'S HAS A POLICY (THE SPENDING POLICY) OF APPROPRIATING FOR EXPENDITURE EACH YEAR 5% OF THE FOUNDATION'S INVESTMENTS AVERAGE FAIR VALUE OVER THE PRIOR 5 YEARS ENDED JUNE 30 PRECEDING THE YEAR IN WHICH EXPENDITURE IS PLANNED. IN ESTABLISHING THIS POLICY, COOK CHILDREN'S CONSIDERED THE LONG-TERM EXPECTED RETURN ON ITS ENDOWMENT. ACCORDINGLY, OVER THE LONG TERM, COOK CHILDREN'S EXPECTS THE CURRENT SPENDING POLICY TO ALLOW ITS ENDOWMENT TO GROW AT THE RETURN HURDLE. THIS IS CONSISTENT WITH COOK CHILDREN'S OBJECTIVE TO MAINTAIN THE PURCHASING POWER OF ENDOWMENT ASSETS HELD IN PERPETUITY OR FOR A SPECIFIED TERM, AS WELL AS TO PROVIDE ADDITIONAL REAL GROWTH THROUGH NEW GIFTS AND INVESTMENT RETURN.
SCHEDULE D, PART XII, LINE 4B	RECONCILATION OF AUDITED EXPENSE TO FORM 990 EXPENSE: BAD DEBT DEDUCTION FROM REVENUE $22,469,046

Schedule D (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

Cook Children's Medical Center

Employer identification number

75-2051646

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 400 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: .........

Yes

200% 250% 300% 350% 400% Other 500 %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..	4,194,038		4,194,038	0.640 %
b	Medicaid (from Worksheet 3, column a) ....	348,588,956	301,034,894	47,554,062	7.280 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	352,782,994	301,034,894	51,748,100	7.920 %
Other Benefits		5,072,772	17,164	5,055,608	0.770 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	5,072,772	17,164	5,055,608	0.770 %
f	Health professions education (from Worksheet 5) ..	575,552	188,134	387,418	0.060 %
g	Subsidized health services (from Worksheet 6) ..
h	Research (from Worksheet 7)	642,325	710,762	-68,437	0.010 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	51,195,795		51,195,795	7.840 %
j	Total. Other Benefits ..	57,486,444	916,060	56,570,384	8.660 %
k	Total. Add lines 7d and 7j .	410,269,438	301,950,954	108,318,484	16.580 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013

Schedule H (Form 990) 2013

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing	26,757	26,757
2	Economic development
3	Community support	1,935	1,935
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	14,306	14,306
7	Community health improvement advocacy	136,985	136,985	0.020 %
8	Workforce development	46,798	46,798	0.010 %
9	Other
10	Total	226,781	226,781	0.030 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

25,588,453

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

2,649,945

Enter Medicare allowable costs of care relating to payments on line 5.....

4,929,513

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-2,279,568

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1CC NORTHEAST HOSP	FREESTANDING SURGICAL HOSP	46.000 %	36.720 %
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2013

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?2 Name, address, primary website address, and state license number
1	COOK CHILDREN'S MEDICAL CENTER 801 SEVENTH AVENUE FORT WORTH,TX76104 www.cookchildrens.org 000332	X
2	COOK CHILDREN'S NORTHEAST HOSPITAL 6316 PRECINCT LINE RD HURST,TX76054 www.cookchildrens.org 008502	X

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	COOK CHILDREN'S MEDICAL CENTER
Name of hospital facility or facility reporting group

If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ....................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................

Yes

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.COOKCHILDRENS.ORG

Other website (list url): WWW.CENTERFORCHILDRENSHEALTH.ORG

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........

Yes

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 400.% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If "Yes," indicate the FPG family income limit for eligibility for discounted care: 500.% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If "Yes," indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Residency
i	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14		No
	If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?..........	17		No
	If "Yes," check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

Policy Relating to Emergency Medical Care

Yes

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................

If "Yes," explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? .........................

If "Yes," explain in Part VI.

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	COOK CHILDREN'S NORTHEAST HOSPITAL
Name of hospital facility or facility reporting group

If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................

Yes

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.COOKCHILDRENS.ORG

Other website (list url): WWW.CENTERFORCHILDRENSHEALTH.ORG

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Yes

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 400.% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If "Yes," indicate the FPG family income limit for eligibility for discounted care: 500.% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If "Yes," indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Residency
i	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14		No
	If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?..........	17		No
	If "Yes," check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

If "Yes," explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? .........................

If "Yes," explain in Part VI.

Schedule H (Form 990) 2013

Page

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference	Explanation
PART V, SECTION B, LINE 3, COOK CHILDREN'S MEDICAL CENTER	INPUT FROM THE COMMUNITY: THE COOK CHILDREN'S COMMUNITY-WIDE CHILDREN'S HEALTH ASSESSMENT AND PLANNING SURVEY (CCHAPS) CONDUCTED IN 2008-2009 INCLUDED A HOUSEHOLD SURVEY OF THE STATUS OF CHILDREN'S HEALTH AGES 0-14 (7,439 COMPLETED SURVEYS), A COMMUNITY LEADER SURVEY, SECONDARY DATA REVIEW, AND MULTIPLE FOCUS GROUPS WITH COMMUNITY LEADERS, 20 COMMUNITY GROUP/COALITION MEETINGS, 12 LISTENING SESSIONS AND 7 INTERNAL MEETINGS. ALL OF THIS WAS DONE TO OBTAIN FEEDBACK FROM APPROXIMATELY 486 EXTERNAL AND 59 INTERNAL COMMUNITY MEMBERS. FEEDBACK FROM GROUP MEETINGS WAS OBTAINED THROUGH DISCUSSION AND A WRITTEN SURVEY. A SECOND CCHAPS WAS CONDUCTED IN 2011-2012 TO UPDATE THE ORIGINAL DATA AND INCLUDED A PARENT SURVEY (8,394 COMPLETED SURVEYS) AND ONE-ON-ONE SURVEY INTERVIEWS WITH PARENTS WHO ARE HOMELESS OR WHO HAVE AT LEAST ONE UNDOCUMENTED FAMILY MEMBER. THE RESULTS OF THE SURVEY WERE COMPARED TO THE 2008 DATA TO SEE HOW CHILDREN'S HEALTH IN THE REGION CHANGED. DISCUSSION GROUPS WERE CONDUCTED WITH THE CHILDREN OF PARENTS WHO PARTICIPATED IN THE SURVEY TO PROVIDE FURTHER INFORMATION ABOUT SURVEY FINDINGS IN PARTNERSHIP WITH COOK CHILDREN'S CHILD LIFE SPECIALISTS. A COMMUNITY LEADER SURVEY AND SPECIAL REPORTS ON PARENTING PRACTICES IN HOOD AND WISE COUNTIES BASED ON ADDITIONAL CCHAPS SURVEYS WERE CONDUCTED IN 2012 AND 2013. PART V, SECTION B, LINE 4 COOK CHILDREN'S MEDICAL CENTER OTHER HOSPITAL FACILITIES: COOK CHILDREN'S MEDICAL CENTER AND COOK CHILDREN'S NORTHEAST HOSPITAL. PART V, SECTION B, LINE 12I, COOK CHILDREN'S MEDICAL CENTER CALCULATING AMOUNTS CHARGED TO PATIENTS: THE HOSPITAL FACILITY USED FEDERAL POVERTY GUIDELINES AND A SLIDING SCALE DISCOUNT TO DETERMINE AMOUNTS DUE DURING THE TAX YEAR. HOUSEHOLD GROSS INCOME AND FAMILY SIZE ARE CONSIDERED IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY STATES AND USES THE FOLLOWING DEFINITION TO DETERMINE AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS. FOLLOWING A DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY, AN INDIVIDUAL WILL NOT BE CHARGED MORE THAN THE AMOUNTS GENERALLY BILLED (AGB) FOR EMERGENCY OR OTHER MEDICAL CARE PROVIDED TO INDIVIDUALS WITH INSURANCE COVERING THAT CARE. AT COOK CHILDREN'S THE AGB IS DETERMINED THROUGH THE "LOOK-BACK METHOD" WHICH IS CALCULATED AS FOLLOWS: 1. THE AGB IS CALCULATED BY REVIEWING ALL PAST CLAIMS THAT HAVE BEEN PAID IN FULL TO THE HOSPITAL FACILITY FOR MEDICALLY NECESSARY CARE BY MEDICARE FEE-FOR-SERVICE TOGETHER WITH ALL PRIVATE HEALTH INSURERS PAYING CLAIMS TO THE HOSPITAL IN A PRIOR 12-MONTH PERIOD. THIS AMOUNT CAN INCLUDE COINSURANCE, COPAYMENTS AND DEDUCTIBLES. 2. THE AGB FOR EMERGENCY OR MEDICALLY NECESSARY CARE PROVIDED TO A FINANCIAL ASSISTANCE-ELIGIBLE INDIVIDUAL IS DETERMINED BY MULTIPLYING GROSS CHARGES FOR THAT CARE BY ONE OR MORE PERCENTAGES OF GROSS CHARGES (CALLED "AGB PERCENTAGES"). a. THE PERCENTAGES ARE CALCULATED AT LEAST ANNUALLY BY DIVIDING THE SUM OF CERTAIN CLAIMS PAID TO THE HOSPITAL FACILITY BY THE SUM OF THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS. b. MULTIPLE AGB PERCENTAGES MAY BE CALCULATED FOR SEPARATE CATEGORIES OF CARE (FOR EXAMPLE, INPATIENT VERSUS OUTPATIENT CARE; OR CARE PROVIDED BY DIFFERENT DEPARTMENTS) OR FOR SEPARATE ITEMS OR SERVICES. 3. THE PERCENTAGES ARE APPLIED BY THE 45TH DAY AFTER THE END OF THE 12-MONTH PERIOD THE HOSPITAL FACILITY USED IN CALCULATING THE AGB PERCENTAGE(S).
PART V, SECTION B, LINE 14G, COOK CHILDREN'S MEDICAL CENTER	MEASURES TO PUBLICIZE THE POLICY: ALTHOUGH THE POLICY DID NOT SPECIFICALLY STATE HOW THE POLICY WOULD BE PUBLICIZED WITHIN THE COMMUNITY DURING THE TAX YEAR, THE FOLLOWING PROCESS HAS BEEN FOLLOWED. ENGLISH AND SPANISH VERSIONS OF A ONE-PAGE DOCUMENT EXPLAINING THE CHARITY CARE OFFERED AT COOK CHILDREN'S ARE POSTED IN EACH OF THE PATIENT REGISTRATION AREAS, THE EMERGENCY ROOM, NIGHT CLINIC, AND MEDICAL OFFICE BUILDING. THIS DOCUMENT INCLUDES INFORMATION ON THE FOLLOWING: 1.HOW ONE MIGHT QUALIFY FOR FINANCIAL ASSISTANCE; 2.EXPLAINS QUALIFICATION IS DETERMINED BY FAMILY SIZE AND INCOME; AND, 3.GUIDES FAMILIES TO CONTACT THE PATIENT ACCOUNTING DEPARTMENT TO APPLY FOR FINANCIAL ASSISTANCE. A FINANCIAL COUNSELOR WILL ASSIST ALL SELF-PAY INPATIENTS, OBSERVATION STAYS AND SCHEDULED PROCEDURES, SCREENING THEM FOR VARIOUS GOVERNMENT PROGRAMS, SUCH AS MEDICAID AND CHIP. IN ADDITION, A FINANCIAL COUNSELOR WILL ASSIST ANY PATIENT THAT PRESENTS TO REGISTRATION FOR FINANCIAL ASSISTANCE, PROVIDING THEM WITH A MEDICAID APPLICATION AND REVIEWING THE CHARITY POLICY. PATIENT REPRESENTATIVES AND CASE MANAGEMENT PERSONNEL ALSO DIRECT FAMILIES TO THE PATIENT REGISTRATION STAFF WHEN THEY NEED FINANCIAL ASSISTANCE. IN ADDITION, THE FINANCIAL ASSISTANCE POLICY, EXPLANATION OF AMOUNTS GENERALLY BILLED AND THE CHARITY APPLICATION ARE POSTED ON THE COOK CHILDREN'S WEBSITE AT WWW.COOKCHILDRENS.ORG. THE CHARITY APPLICATION IS POSTED IN BOTH ENGLISH AND SPANISH VERSIONS.
PART V, SECTION B, LINE 18E, COOK CHILDREN'S MEDICAL CENTER	COLLECTION ACTIONS TAKEN: THE HOSPITAL FACILITY DID NOT TAKE ANY OF THE ACTIONS LISTED ON LINE 17. PART V, SECTION B, LINE 20D, COOK CHILDREN'S MEDICAL CENTER AMOUNTS CHARGED: SEE RESPONSE TO SCHEDULE H, PART V, SECTION B, LINE 12I LISTED ABOVE.
PART V, SECTION B, LINE 3, COOK CHILDREN'S NORTHEAST HOSPITAL	INPUT FROM THE COMMUNITY: THE COOK CHILDREN'S COMMUNITY-WIDE CHILDREN'S HEALTH ASSESSMENT AND PLANNING SURVEY (CCHAPS) CONDUCTED IN 2008-2009 INCLUDED A HOUSEHOLD SURVEY OF THE STATUS OF CHILDREN'S HEALTH AGES 0-14 (7,439 COMPLETED SURVEYS), A COMMUNITY LEADER SURVEY, SECONDARY DATA REVIEW, AND MULTIPLE FOCUS GROUPS WITH COMMUNITY LEADERS, 20 COMMUNITY GROUP/COALITION MEETINGS, 12 LISTENING SESSIONS AND 7 INTERNAL MEETINGS. ALL OF THIS WAS DONE TO OBTAIN FEEDBACK FROM APPROXIMATELY 486 EXTERNAL AND 59 INTERNAL COMMUNITY MEMBERS. FEEDBACK FROM GROUP MEETINGS WAS OBTAINED THROUGH DISCUSSION AND A WRITTEN SURVEY. A SECOND CCHAPS WAS CONDUCTED IN 2011-2012 TO UPDATE THE ORIGINAL DATA AND INCLUDED A PARENT SURVEY (8,394 COMPLETED SURVEYS) AND ONE-ON-ONE SURVEY INTERVIEWS WITH PARENTS WHO ARE HOMELESS OR WHO HAVE AT LEAST ONE UNDOCUMENTED FAMILY MEMBER. THE RESULTS OF THE SURVEY WERE COMPARED TO THE 2008 DATA TO SEE HOW CHILDREN'S HEALTH IN THE REGION CHANGED. DISCUSSION GROUPS WERE CONDUCTED WITH THE CHILDREN OF PARENTS WHO PARTICIPATED IN THE SURVEY TO PROVIDE FURTHER INFORMATION ABOUT SURVEY FINDINGS IN PARTNERSHIP WITH COOK CHILDREN'S CHILD LIFE SPECIALISTS. A COMMUNITY LEADER SURVEY AND SPECIAL REPORTS ON PARENTING PRACTICES IN HOOD AND WISE COUNTIES BASED ON ADDITIONAL CCHAPS SURVEYS WERE CONDUCTED IN 2012 AND 2013. PART V, SECTION B, LINE 4 COOK CHILDREN'S NORTHEAST HOSPITAL OTHER HOSPITAL FACILITIES: COOK CHILDREN'S MEDICAL CENTER AND COOK CHILDREN'S NORTHEAST HOSPITAL. PART V, SECTION B, LINE 12I, COOK CHILDREN'S NORTHEAST HOSPITAL CALCULATING AMOUNTS CHARGED TO PATIENTS: THE HOSPITAL FACILITY USED FEDERAL POVERTY GUIDELINES AND A SLIDING SCALE DISCOUNT TO DETERMINE AMOUNTS DUE DURING THE TAX YEAR. HOUSEHOLD GROSS INCOME AND FAMILY SIZE ARE CONSIDERED IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY STATES AND USES THE FOLLOWING DEFINITION TO DETERMINE AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS. FOLLOWING A DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY, AN INDIVIDUAL WILL NOT BE CHARGED MORE THAN THE AMOUNTS GENERALLY BILLED (AGB) FOR EMERGENCY OR OTHER MEDICAL CARE PROVIDED TO INDIVIDUALS WITH INSURANCE COVERING THAT CARE. AT COOK CHILDREN'S THE AGB IS DETERMINED THROUGH THE "LOOK-BACK METHOD" WHICH IS CALCULATED AS FOLLOWS: 1. THE AGB IS CALCULATED BY REVIEWING ALL PAST CLAIMS THAT HAVE BEEN PAID IN FULL TO THE HOSPITAL FACILITY FOR MEDICALLY NECESSARY CARE BY MEDICARE FEE-FOR-SERVICE TOGETHER WITH ALL PRIVATE HEALTH INSURERS PAYING CLAIMS TO THE HOSPITAL IN A PRIOR 12-MONTH PERIOD. THIS AMOUNT CAN INCLUDE COINSURANCE, COPAYMENTS AND DEDUCTIBLES. 2. THE AGB FOR EMERGENCY OR MEDICALLY NECESSARY CARE PROVIDED TO A FINANCIAL ASSISTANCE-ELIGIBLE INDIVIDUAL IS DETERMINED BY MULTIPLYING GROSS CHARGES FOR THAT CARE BY ONE OR MORE PERCENTAGES OF GROSS CHARGES (CALLED "AGB PERCENTAGES"). a. THE PERCENTAGES ARE CALCULATED AT LEAST ANNUALLY BY DIVIDING THE SUM OF CERTAIN CLAIMS PAID TO THE HOSPITAL FACILITY BY THE SUM OF THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS. b. MULTIPLE AGB PERCENTAGES MAY BE CALCULATED FOR SEPARATE CATEGORIES OF CARE (FOR EXAMPLE, INPATIENT VERSUS OUTPATIENT CARE; OR CARE PROVIDED BY DIFFERENT DEPARTMENTS) OR FOR SEPARATE ITEMS OR SERVICES. 3. THE PERCENTAGES ARE APPLIED BY THE 45TH DAY AFTER THE END OF THE 12-MONTH PERIOD THE HOSPITAL FACILITY USED IN CALCULATING THE AGB PERCENTAGE(S).
PART V, SECTION B, LINE 14G, COOK CHILDREN'S NORTHEAST HOSPITAL	MEASURES TO PUBLICIZE THE POLICY: ALTHOUGH THE POLICY DID NOT SPECIFICALLY STATE HOW THE POLICY WOULD BE PUBLICIZED WITHIN THE COMMUNITY DURING THE TAX YEAR, THE FOLLOWING PROCESS HAS BEEN FOLLOWED. ENGLISH AND SPANISH VERSIONS OF A ONE-PAGE DOCUMENT EXPLAINING THE CHARITY CARE OFFERED AT COOK CHILDREN'S ARE POSTED IN EACH OF THE PATIENT REGISTRATION AREAS, THE EMERGENCY ROOM, NIGHT CLINIC, AND MEDICAL OFFICE BUILDING. THIS DOCUMENT INCLUDES INFORMATION ON THE FOLLOWING: 1.HOW ONE MIGHT QUALIFY FOR FINANCIAL ASSISTANCE; 2.EXPLAINS QUALIFICATION IS DETERMINED BY FAMILY SIZE AND INCOME; AND, 3.GUIDES FAMILIES TO CONTACT THE PATIENT ACCOUNTING DEPARTMENT TO APPLY FOR FINANCIAL ASSISTANCE. A FINANCIAL COUNSELOR WILL ASSIST ALL SELF-PAY INPATIENTS, OBSERVATION STAYS AND SCHEDULED PROCEDURES, SCREENING THEM FOR VARIOUS GOVERNMENT PROGRAMS, SUCH AS MEDICAID AND CHIP. IN ADDITION, A FINANCIAL COUNSELOR WILL ASSIST ANY PATIENT THAT PRESENTS TO REGISTRATION FOR FINANCIAL ASSISTANCE, PROVIDING THEM WITH A MEDICAID APPLICATION AND REVIEWING THE CHARITY POLICY. PATIENT REPRESENTATIVES AND CASE MANAGEMENT PERSONNEL ALSO DIRECT FAMILIES TO THE PATIENT REGISTRATION STAFF WHEN THEY NEED FINANCIAL ASSISTANCE. IN ADDITION, THE FINANCIAL ASSISTANCE POLICY, EXPLANATION OF AMOUNTS GENERALLY BILLED AND THE CHARITY APPLICATION ARE POSTED ON THE COOK CHILDREN'S WEBSITE AT WWW.COOKCHILDRENS.ORG. THE CHARITY APPLICATION IS POSTED IN BOTH ENGLISH AND SPANISH VERSIONS.
PART V, SECTION B, LINE 18E, COOK CHILDREN'S NORTHEAST HOSPITAL	COLLECTION ACTIONS TAKEN: THE HOSPITAL FACILITY DID NOT TAKE ANY OF THE ACTIONS LISTED ON LINE 17. PART V, SECTION B, LINE 20D, COOK CHILDREN'S NORTHEAST HOSPITAL AMOUNTS CHARGED: SEE RESPONSE TO SCHEDULE H, PART V, SECTION B, LINE 12I LISTED ABOVE.
PART V, SECTION B, LINE 6A	IMPLEMENTATION STRATEGY: THE ORGANIZATION'S IMPLEMENTATION STRATEGY IS LOCATED AT THE FOLLOWING WEBSITE: HTTP://WWW.COOKCHILDRENS.ORG/SITECOLLECTIONDOCUMENTS/ABOUTUS/CHNA-IMPLEMEN TATION-STRATEGIES.PDF

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?1
Name and address		Type of Facility (describe)
1	CENTER FOR PEDIATRIC SURGERY 7000 W PLANO PARKWAY STE 100 PLANO,TX75093	AMBULATORY SURGERY CENTER
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2013

Page

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART V, SECTION B, LINE 3, COOK CHILDREN'S MEDICAL CENTER	INPUT FROM THE COMMUNITY: THE COOK CHILDREN'S COMMUNITY-WIDE CHILDREN'S HEALTH ASSESSMENT AND PLANNING SURVEY (CCHAPS) CONDUCTED IN 2008-2009 INCLUDED A HOUSEHOLD SURVEY OF THE STATUS OF CHILDREN'S HEALTH AGES 0-14 (7,439 COMPLETED SURVEYS), A COMMUNITY LEADER SURVEY, SECONDARY DATA REVIEW, AND MULTIPLE FOCUS GROUPS WITH COMMUNITY LEADERS, 20 COMMUNITY GROUP/COALITION MEETINGS, 12 LISTENING SESSIONS AND 7 INTERNAL MEETINGS. ALL OF THIS WAS DONE TO OBTAIN FEEDBACK FROM APPROXIMATELY 486 EXTERNAL AND 59 INTERNAL COMMUNITY MEMBERS. FEEDBACK FROM GROUP MEETINGS WAS OBTAINED THROUGH DISCUSSION AND A WRITTEN SURVEY. A SECOND CCHAPS WAS CONDUCTED IN 2011-2012 TO UPDATE THE ORIGINAL DATA AND INCLUDED A PARENT SURVEY (8,394 COMPLETED SURVEYS) AND ONE-ON-ONE SURVEY INTERVIEWS WITH PARENTS WHO ARE HOMELESS OR WHO HAVE AT LEAST ONE UNDOCUMENTED FAMILY MEMBER. THE RESULTS OF THE SURVEY WERE COMPARED TO THE 2008 DATA TO SEE HOW CHILDREN'S HEALTH IN THE REGION CHANGED. DISCUSSION GROUPS WERE CONDUCTED WITH THE CHILDREN OF PARENTS WHO PARTICIPATED IN THE SURVEY TO PROVIDE FURTHER INFORMATION ABOUT SURVEY FINDINGS IN PARTNERSHIP WITH COOK CHILDREN'S CHILD LIFE SPECIALISTS. A COMMUNITY LEADER SURVEY AND SPECIAL REPORTS ON PARENTING PRACTICES IN HOOD AND WISE COUNTIES BASED ON ADDITIONAL CCHAPS SURVEYS WERE CONDUCTED IN 2012 AND 2013. PART V, SECTION B, LINE 4 COOK CHILDREN'S MEDICAL CENTER OTHER HOSPITAL FACILITIES: COOK CHILDREN'S MEDICAL CENTER AND COOK CHILDREN'S NORTHEAST HOSPITAL. PART V, SECTION B, LINE 12I, COOK CHILDREN'S MEDICAL CENTER CALCULATING AMOUNTS CHARGED TO PATIENTS: THE HOSPITAL FACILITY USED FEDERAL POVERTY GUIDELINES AND A SLIDING SCALE DISCOUNT TO DETERMINE AMOUNTS DUE DURING THE TAX YEAR. HOUSEHOLD GROSS INCOME AND FAMILY SIZE ARE CONSIDERED IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY STATES AND USES THE FOLLOWING DEFINITION TO DETERMINE AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS. FOLLOWING A DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY, AN INDIVIDUAL WILL NOT BE CHARGED MORE THAN THE AMOUNTS GENERALLY BILLED (AGB) FOR EMERGENCY OR OTHER MEDICAL CARE PROVIDED TO INDIVIDUALS WITH INSURANCE COVERING THAT CARE. AT COOK CHILDREN'S THE AGB IS DETERMINED THROUGH THE "LOOK-BACK METHOD" WHICH IS CALCULATED AS FOLLOWS: 1. THE AGB IS CALCULATED BY REVIEWING ALL PAST CLAIMS THAT HAVE BEEN PAID IN FULL TO THE HOSPITAL FACILITY FOR MEDICALLY NECESSARY CARE BY MEDICARE FEE-FOR-SERVICE TOGETHER WITH ALL PRIVATE HEALTH INSURERS PAYING CLAIMS TO THE HOSPITAL IN A PRIOR 12-MONTH PERIOD. THIS AMOUNT CAN INCLUDE COINSURANCE, COPAYMENTS AND DEDUCTIBLES. 2. THE AGB FOR EMERGENCY OR MEDICALLY NECESSARY CARE PROVIDED TO A FINANCIAL ASSISTANCE-ELIGIBLE INDIVIDUAL IS DETERMINED BY MULTIPLYING GROSS CHARGES FOR THAT CARE BY ONE OR MORE PERCENTAGES OF GROSS CHARGES (CALLED "AGB PERCENTAGES"). a. THE PERCENTAGES ARE CALCULATED AT LEAST ANNUALLY BY DIVIDING THE SUM OF CERTAIN CLAIMS PAID TO THE HOSPITAL FACILITY BY THE SUM OF THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS. b. MULTIPLE AGB PERCENTAGES MAY BE CALCULATED FOR SEPARATE CATEGORIES OF CARE (FOR EXAMPLE, INPATIENT VERSUS OUTPATIENT CARE; OR CARE PROVIDED BY DIFFERENT DEPARTMENTS) OR FOR SEPARATE ITEMS OR SERVICES. 3. THE PERCENTAGES ARE APPLIED BY THE 45TH DAY AFTER THE END OF THE 12-MONTH PERIOD THE HOSPITAL FACILITY USED IN CALCULATING THE AGB PERCENTAGE(S).
PART V, SECTION B, LINE 14G, COOK CHILDREN'S MEDICAL CENTER	MEASURES TO PUBLICIZE THE POLICY: ALTHOUGH THE POLICY DID NOT SPECIFICALLY STATE HOW THE POLICY WOULD BE PUBLICIZED WITHIN THE COMMUNITY DURING THE TAX YEAR, THE FOLLOWING PROCESS HAS BEEN FOLLOWED. ENGLISH AND SPANISH VERSIONS OF A ONE-PAGE DOCUMENT EXPLAINING THE CHARITY CARE OFFERED AT COOK CHILDREN'S ARE POSTED IN EACH OF THE PATIENT REGISTRATION AREAS, THE EMERGENCY ROOM, NIGHT CLINIC, AND MEDICAL OFFICE BUILDING. THIS DOCUMENT INCLUDES INFORMATION ON THE FOLLOWING: 1.HOW ONE MIGHT QUALIFY FOR FINANCIAL ASSISTANCE; 2.EXPLAINS QUALIFICATION IS DETERMINED BY FAMILY SIZE AND INCOME; AND, 3.GUIDES FAMILIES TO CONTACT THE PATIENT ACCOUNTING DEPARTMENT TO APPLY FOR FINANCIAL ASSISTANCE. A FINANCIAL COUNSELOR WILL ASSIST ALL SELF-PAY INPATIENTS, OBSERVATION STAYS AND SCHEDULED PROCEDURES, SCREENING THEM FOR VARIOUS GOVERNMENT PROGRAMS, SUCH AS MEDICAID AND CHIP. IN ADDITION, A FINANCIAL COUNSELOR WILL ASSIST ANY PATIENT THAT PRESENTS TO REGISTRATION FOR FINANCIAL ASSISTANCE, PROVIDING THEM WITH A MEDICAID APPLICATION AND REVIEWING THE CHARITY POLICY. PATIENT REPRESENTATIVES AND CASE MANAGEMENT PERSONNEL ALSO DIRECT FAMILIES TO THE PATIENT REGISTRATION STAFF WHEN THEY NEED FINANCIAL ASSISTANCE. IN ADDITION, THE FINANCIAL ASSISTANCE POLICY, EXPLANATION OF AMOUNTS GENERALLY BILLED AND THE CHARITY APPLICATION ARE POSTED ON THE COOK CHILDREN'S WEBSITE AT WWW.COOKCHILDRENS.ORG. THE CHARITY APPLICATION IS POSTED IN BOTH ENGLISH AND SPANISH VERSIONS.
PART V, SECTION B, LINE 18E, COOK CHILDREN'S MEDICAL CENTER	COLLECTION ACTIONS TAKEN: THE HOSPITAL FACILITY DID NOT TAKE ANY OF THE ACTIONS LISTED ON LINE 17. PART V, SECTION B, LINE 20D, COOK CHILDREN'S MEDICAL CENTER AMOUNTS CHARGED: SEE RESPONSE TO SCHEDULE H, PART V, SECTION B, LINE 12I LISTED ABOVE.
PART V, SECTION B, LINE 3, COOK CHILDREN'S NORTHEAST HOSPITAL	INPUT FROM THE COMMUNITY: THE COOK CHILDREN'S COMMUNITY-WIDE CHILDREN'S HEALTH ASSESSMENT AND PLANNING SURVEY (CCHAPS) CONDUCTED IN 2008-2009 INCLUDED A HOUSEHOLD SURVEY OF THE STATUS OF CHILDREN'S HEALTH AGES 0-14 (7,439 COMPLETED SURVEYS), A COMMUNITY LEADER SURVEY, SECONDARY DATA REVIEW, AND MULTIPLE FOCUS GROUPS WITH COMMUNITY LEADERS, 20 COMMUNITY GROUP/COALITION MEETINGS, 12 LISTENING SESSIONS AND 7 INTERNAL MEETINGS. ALL OF THIS WAS DONE TO OBTAIN FEEDBACK FROM APPROXIMATELY 486 EXTERNAL AND 59 INTERNAL COMMUNITY MEMBERS. FEEDBACK FROM GROUP MEETINGS WAS OBTAINED THROUGH DISCUSSION AND A WRITTEN SURVEY. A SECOND CCHAPS WAS CONDUCTED IN 2011-2012 TO UPDATE THE ORIGINAL DATA AND INCLUDED A PARENT SURVEY (8,394 COMPLETED SURVEYS) AND ONE-ON-ONE SURVEY INTERVIEWS WITH PARENTS WHO ARE HOMELESS OR WHO HAVE AT LEAST ONE UNDOCUMENTED FAMILY MEMBER. THE RESULTS OF THE SURVEY WERE COMPARED TO THE 2008 DATA TO SEE HOW CHILDREN'S HEALTH IN THE REGION CHANGED. DISCUSSION GROUPS WERE CONDUCTED WITH THE CHILDREN OF PARENTS WHO PARTICIPATED IN THE SURVEY TO PROVIDE FURTHER INFORMATION ABOUT SURVEY FINDINGS IN PARTNERSHIP WITH COOK CHILDREN'S CHILD LIFE SPECIALISTS. A COMMUNITY LEADER SURVEY AND SPECIAL REPORTS ON PARENTING PRACTICES IN HOOD AND WISE COUNTIES BASED ON ADDITIONAL CCHAPS SURVEYS WERE CONDUCTED IN 2012 AND 2013. PART V, SECTION B, LINE 4 COOK CHILDREN'S NORTHEAST HOSPITAL OTHER HOSPITAL FACILITIES: COOK CHILDREN'S MEDICAL CENTER AND COOK CHILDREN'S NORTHEAST HOSPITAL. PART V, SECTION B, LINE 12I, COOK CHILDREN'S NORTHEAST HOSPITAL CALCULATING AMOUNTS CHARGED TO PATIENTS: THE HOSPITAL FACILITY USED FEDERAL POVERTY GUIDELINES AND A SLIDING SCALE DISCOUNT TO DETERMINE AMOUNTS DUE DURING THE TAX YEAR. HOUSEHOLD GROSS INCOME AND FAMILY SIZE ARE CONSIDERED IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY STATES AND USES THE FOLLOWING DEFINITION TO DETERMINE AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS. FOLLOWING A DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY, AN INDIVIDUAL WILL NOT BE CHARGED MORE THAN THE AMOUNTS GENERALLY BILLED (AGB) FOR EMERGENCY OR OTHER MEDICAL CARE PROVIDED TO INDIVIDUALS WITH INSURANCE COVERING THAT CARE. AT COOK CHILDREN'S THE AGB IS DETERMINED THROUGH THE "LOOK-BACK METHOD" WHICH IS CALCULATED AS FOLLOWS: 1. THE AGB IS CALCULATED BY REVIEWING ALL PAST CLAIMS THAT HAVE BEEN PAID IN FULL TO THE HOSPITAL FACILITY FOR MEDICALLY NECESSARY CARE BY MEDICARE FEE-FOR-SERVICE TOGETHER WITH ALL PRIVATE HEALTH INSURERS PAYING CLAIMS TO THE HOSPITAL IN A PRIOR 12-MONTH PERIOD. THIS AMOUNT CAN INCLUDE COINSURANCE, COPAYMENTS AND DEDUCTIBLES. 2. THE AGB FOR EMERGENCY OR MEDICALLY NECESSARY CARE PROVIDED TO A FINANCIAL ASSISTANCE-ELIGIBLE INDIVIDUAL IS DETERMINED BY MULTIPLYING GROSS CHARGES FOR THAT CARE BY ONE OR MORE PERCENTAGES OF GROSS CHARGES (CALLED "AGB PERCENTAGES"). a. THE PERCENTAGES ARE CALCULATED AT LEAST ANNUALLY BY DIVIDING THE SUM OF CERTAIN CLAIMS PAID TO THE HOSPITAL FACILITY BY THE SUM OF THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS. b. MULTIPLE AGB PERCENTAGES MAY BE CALCULATED FOR SEPARATE CATEGORIES OF CARE (FOR EXAMPLE, INPATIENT VERSUS OUTPATIENT CARE; OR CARE PROVIDED BY DIFFERENT DEPARTMENTS) OR FOR SEPARATE ITEMS OR SERVICES. 3. THE PERCENTAGES ARE APPLIED BY THE 45TH DAY AFTER THE END OF THE 12-MONTH PERIOD THE HOSPITAL FACILITY USED IN CALCULATING THE AGB PERCENTAGE(S).
PART V, SECTION B, LINE 14G, COOK CHILDREN'S NORTHEAST HOSPITAL	MEASURES TO PUBLICIZE THE POLICY: ALTHOUGH THE POLICY DID NOT SPECIFICALLY STATE HOW THE POLICY WOULD BE PUBLICIZED WITHIN THE COMMUNITY DURING THE TAX YEAR, THE FOLLOWING PROCESS HAS BEEN FOLLOWED. ENGLISH AND SPANISH VERSIONS OF A ONE-PAGE DOCUMENT EXPLAINING THE CHARITY CARE OFFERED AT COOK CHILDREN'S ARE POSTED IN EACH OF THE PATIENT REGISTRATION AREAS, THE EMERGENCY ROOM, NIGHT CLINIC, AND MEDICAL OFFICE BUILDING. THIS DOCUMENT INCLUDES INFORMATION ON THE FOLLOWING: 1.HOW ONE MIGHT QUALIFY FOR FINANCIAL ASSISTANCE; 2.EXPLAINS QUALIFICATION IS DETERMINED BY FAMILY SIZE AND INCOME; AND, 3.GUIDES FAMILIES TO CONTACT THE PATIENT ACCOUNTING DEPARTMENT TO APPLY FOR FINANCIAL ASSISTANCE. A FINANCIAL COUNSELOR WILL ASSIST ALL SELF-PAY INPATIENTS, OBSERVATION STAYS AND SCHEDULED PROCEDURES, SCREENING THEM FOR VARIOUS GOVERNMENT PROGRAMS, SUCH AS MEDICAID AND CHIP. IN ADDITION, A FINANCIAL COUNSELOR WILL ASSIST ANY PATIENT THAT PRESENTS TO REGISTRATION FOR FINANCIAL ASSISTANCE, PROVIDING THEM WITH A MEDICAID APPLICATION AND REVIEWING THE CHARITY POLICY. PATIENT REPRESENTATIVES AND CASE MANAGEMENT PERSONNEL ALSO DIRECT FAMILIES TO THE PATIENT REGISTRATION STAFF WHEN THEY NEED FINANCIAL ASSISTANCE. IN ADDITION, THE FINANCIAL ASSISTANCE POLICY, EXPLANATION OF AMOUNTS GENERALLY BILLED AND THE CHARITY APPLICATION ARE POSTED ON THE COOK CHILDREN'S WEBSITE AT WWW.COOKCHILDRENS.ORG. THE CHARITY APPLICATION IS POSTED IN BOTH ENGLISH AND SPANISH VERSIONS.
PART V, SECTION B, LINE 18E, COOK CHILDREN'S NORTHEAST HOSPITAL	COLLECTION ACTIONS TAKEN: THE HOSPITAL FACILITY DID NOT TAKE ANY OF THE ACTIONS LISTED ON LINE 17. PART V, SECTION B, LINE 20D, COOK CHILDREN'S NORTHEAST HOSPITAL AMOUNTS CHARGED: SEE RESPONSE TO SCHEDULE H, PART V, SECTION B, LINE 12I LISTED ABOVE.
PART V, SECTION B, LINE 6A	IMPLEMENTATION STRATEGY: THE ORGANIZATION'S IMPLEMENTATION STRATEGY IS LOCATED AT THE FOLLOWING WEBSITE: HTTP://WWW.COOKCHILDRENS.ORG/SITECOLLECTIONDOCUMENTS/ABOUTUS/CHNA-IMPLEMEN TATION-STRATEGIES.PDF

Schedule H (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990
lBullet

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization
Cook Children's Medical Center

Employer identification number
75-2051646

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2013

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant
(1) TRANSPORTATION	657	30,510
(2) LODGING	66	16,522
(3) MEDICAL EQUIPMENT	14	12,075
(4) BABY SUPPLIES	84	5,851
(5) GIFT CARDS	108	4,720
(6) MEALS	220	4,490
(7) UTILITIES	12	3,666
(8) MEDICATIONS	4	438
(9) FUNERAL	4	1,950
(10) OTHER	4	19
(11) CITIZENSHIP	1	1,170

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference	Explanation
SCHEDULE I PART I QUESTION 2	PROCEDURES FOR MONITORING THE USE OF THE GRANT FUNDS IN THE US: THE ORGANIZATION USES PUBLIC AND PRIVATE DATA TO MONITOR THE USE OF FUNDS, AS NEEDED.

Schedule I (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

Cook Children's Medical Center

Employer identification number

75-2051646

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2013

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1)NANCY C CYCHOLPRESIDENT	(i) (ii)	396,807	186,002	120,569	19,125	9,408	731,911
(2)STANLEY E DAVISVP, SUPPORT SERVICES	(i) (ii)	184,302	65,487	2,017	11,869	15,807	279,482
(3)RICHARD P GOODECHIEF FINANCIAL OFFICER	(i) (ii)	171,338 140,186	98,001 80,183	98,485 80,578	8,766 7,172	7,234 5,919	383,824 314,038
(4)RICK W MERRILLCHIEF EXECUTIVE OFFICER	(i) (ii)	218,943 510,869	128,746 300,406	53,725 125,357	52,425 122,325	4,750 11,082	458,589 1,070,039	48,600 113,400
(5)GEORGE B MONTAGUEVP, REAL ESTATE	(i) (ii)	216,368	69,281	21,644	19,125	12,446	338,864
(6)PAULA J WEBBVP, NURSING	(i) (ii)	223,553	77,922	5,552	13,131	9,444	329,602
(7)TARESA J CLARKVP, NURSING/CNO	(i) (ii)	170,818	60,521	16,891	11,198	11,719	271,147
(8)JACK SOSEBEEVP, FAMILY SUPPORT SVCS	(i) (ii)	143,138	32,480	7,506	14,106	9,590	206,820
(9)BRADLEY HORNPHARMACIST	(i) (ii)	181,743		10,121	12,052	9,984	213,900
(10)ROSANNE THURMANDIRECTOR, PHARMACY	(i) (ii)	150,592	20,571	7,285	7,290	12,191	197,929
(11)KEVIN L DAHLEPHARMACIST	(i) (ii)	164,136		13,142	11,061	12,164	200,503
(12)KIMBERLY JONESAVP-PERIOPERATIVE SVCS	(i) (ii)	220,913	54,052	1,160	10,200	17,316	303,641
(13)SHARON SMITHDIRECTOR-AMBULATORY SURG SVCS	(i) (ii)	41,629		159,380	7,131	2,274	210,414

Schedule J (Form 990) 2013

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.

Return Reference	Explanation
PART I, QUESTION 4B	PARTICIPATION IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: PARTICIPANTS IN SERP REPORTED IN W-2 DEFERRED COMPENSATION -------------------- --------------- --------------------- RICK W. MERRILL $ 136,311 $ 162,000 NANCY C. CYCHOL $ 81,745 NONE RICHARD P. GOODE $ 71,371 NONE
PART II	ALLOCATION OF CEO AND CFO SALARIES: SALARIES FOR THE CEO AND CFO ARE ALLOCATED PRO-RATA BASED ON THE AMOUNT OF TIME THEY SPEND WITH EACH OF THE FOLLOWING COMPANIES: COOK CHILDREN'S MEDICAL CENTER COOK CHILDREN'S HEALTH FOUNDATION COOK CHILDREN'S HOME HEALTH COOK CHILDREN'S HEALTH CARE SYSTEM COOK CHILDREN'S HEALTH PLAN
PART I, QUESTION 4A	RECEIVED SEVERANCE PAYMENTS: NAME AMOUNT ------------ --------- SHARON SMITH $ 106,111
PART I, QUESTIONS 1A & 1B	TAX INDEMNIFICATION AND GROSS-UP PAYMENTS: THERE IS NO WRITTEN POLICY REGARDING PAYMENT OR REIMBURSEMENT OF TAX INDEMNIFICATION AND GROSS-UP PAYMENTS BECAUSE THE COMPANY DOES NOT GENERALLY ALLOW FOR GROSS-UPS IN TAX PAYMENTS EXCEPT IN UNUSUAL CIRCUMSTANCES AND ONLY THEN IF APPROVED BY SENIOR MANAGEMENT. IN THIS CASE, $500.00 GIFT CARDS WERE DISTRIBUTED AT CHRISTMAS TO NON-EXECUTIVE EMPLOYEES. THE SENIOR VICE PRESIDENT OF HUMAN RESOURCES APPROVED THE GROSS-UP OF $125.00 PER CARD SO THAT EMPLOYEES WOULD RECEIVE THE FULL STATED BENEFIT OF THE GIFT CARD.
PART I, QUESTION 3	METHODS USED BY CCHCS TO ESTABLISH COMPENSATION OF THE CEO/EXEC DIRECTOR: COMPENSATION COMMITTEE INDEPENDENT COMPENSATION CONSULTANT WRITTEN EMPLOYMENT CONTRACT COMPENSATION SURVEY OR STUDY APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE

Schedule J (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990. SchKMediumBullet

See separate instructions.
SchKMediumBullet

Information about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization
Cook Children's Medical Center

Employer identification number
75-2051646

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	TARRANT COUNTY HEALTH FACILITIES DEVELOPMENT	75-1881060	875906MV8	06-27-2007	52,156,976	REFUNDING BONDS 2000 & 2005		X		X		X
B	BELL COUNTY HEALTH FACILITIES DEVELOPMENT CORP	74-2218760	078027HW2	06-27-2007	17,523,594	REFUNDING BONDS ISSUED 7/19/2000		X		X		X
C	TARRANT COUNTY HEALTH FACILITIES DEVELOPMENT	75-1881060	875906NY1	02-04-2010	231,948,097	DEVELOPMENT, CONSTR, EQUIPMENT COS		X		X		X
D	TARRANT COUNTY CULTURAL EDUCATION FACILITIES FINAN	04-3833551	87638QJC4	08-01-2013	71,222,592	REFUNDING PORTION OF 2010 BOND SER		X		X		X
	TARRANT COUNTY CULTURAL EDUCATION FACILITIES FINAN	04-3833551	87638QKX6	02-28-2014	176,767,688	CONSTRUCTION AND EQUIPMENT COSTS		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . . .	0		0		70,110,000		0
2 Amount of bonds legally defeased . . . . . . . . . . .	0		0		0		0
3 Total proceeds of issue . . . . . . . . . . . . . .	52,156,976		17,523,594		232,805,916		71,222,592
4 Gross proceeds in reserve funds . . . . . . . . . . . .	0		0		0		0
5 Capitalized interest from proceeds . . . . . . . . . . .	0		0		0		0
6 Proceeds in refunding escrows . . . . . . . . . . . .	50,833,752		17,116,642		0		70,145,033
7 Issuance costs from proceeds . . . . . . . . . . . .	672,932		229,475		2,686,446		1,077,553
8 Credit enhancement from proceeds . . . . . . . . . . .	650,292		177,477		0		0
9 Working capital expenditures from proceeds . . . . . . . . .	0		0		0		0
10 Capital expenditures from proceeds . . . . . . . . . . .	0		0		230,119,470		0
11 Other spent proceeds . . . . . . . . . . . . . .	0		0		0		0
12 Other unspent proceeds . . . . . . . . . . . . . .	0		0		0		0
13 Year of substantial completion . . . . . . . . . . . .	2007		2007		2011		2013
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . . .	X			X		X	X
15 Were the bonds issued as part of an advance refunding issue? . . . . .		X	X			X		X
16 Has the final allocation of proceeds been made? . . . . . . . .	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . .	X		X		X		X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .		X		X	X			X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2013

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .		X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .		X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . .	0 %		0 %		0.260 %		0.080 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . .	0 %						0 %
6 Total of lines 4 and 5 . . . . . . . . . . . . .	0.260 %				0.260 %		0.080 %
7 Does the bond issue meet the private security or payment test? . . . . .	X				X		X
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of.
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .		X		X		X		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? . . . . . . .	X		X		X		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T? . . . . .		X		X		X		X
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .
b Exception to rebate? . . . . . . . .
c No rebate due? . . . . . . . .	X		X		X		X
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .		X		X	X			X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider . . . . . . . . .	0		0		0
c Term of hedge . . . . . . . . . .
d Was the hedge superintegrated? . . . .
e Was the hedge terminated? . . . . . .

Schedule K (Form 990) 2013

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .		X		X		X		X
b Name of provider . . . . . . . . .	0		0		0		0
c Term of GIC . . . . . . . . . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .	X		X		X		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part VI

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
PART II, COLUMN C, LINE 3	TOTAL PROCEEDS OF ISSUE TOTAL PROCEEDS INCLUDE INVESTMENT EARNINGS.
PART IV, COLUMN A & B, LINE 2C	NO REBATE DUE THE FINAL REBATE COMPUTATION WAS PERFORMED AS OF 6/27/2012.
PART IV, COLUMN C, LINE 2C	NO REBATE DUE THE FINAL REBATE COMPUTATION WAS PERFORMED AS OF 2/4/2014.
PART IV, COLUMN D, LINE 2C	NO REBATE DUE THE FINAL REBATE COMPUTATION WAS PERFORMED AS OF 2/4/2014.
PART III, LINE 7, COLUMNS C & D	FOR THE PURPOSES OF CALCULATING THE PRIVATE SECURITY OR PAYMENT TEST, COOK CHILDREN'S MEDICAL CENTER (CCMC) HAS INCLUDED GROSS RECEIPTS FROM CERTAIN ACTIVITIES THAT CCMC HAS CONCLUDED GENERATE PRIVATE PAYMENTS. CALCULATED IN THAT MANNER, CCMC HAS CONCLUDED THAT THE PRIVATE PAYMENT TEST HAS BEEN MET WITH RESPECT TO THE BOND ISSUES DESCRIBED IN COLUMNS C & D. HOWEVER, THE AMOUNT OF PRIVATE BUSINESS USE WITH RESPECT TO THE BOND ISSUES DESCRIBED IN COLUMNS C & D IS LESS THAN 5%, IN EACH CASE, SO THAT EACH OF THOSE BOND ISSUES FAILS THE PRIVATE BUSINESS USE TEST AND CONTINUES TO MEET THE REQUIREMENTS IMPOSED ON "QUALIFIED 501(C)(3) BONDS."
PART II, COLUMN A, LINE 3 (2014 ISSUE)	TOTAL PROCEEDS INCLUDE INVESTMENT EARNINGS.
PART IV, COLUMN A, LINE 2C (2014 ISSUE)	NO REBATE DUE THE REBATE COMPUTATION WAS PERFORMED AS OF 2/28/2015.

Schedule K (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990. SchKMediumBullet

See separate instructions.
SchKMediumBullet

Information about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization
Cook Children's Medical Center

Employer identification number
75-2051646

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	TARRANT COUNTY HEALTH FACILITIES DEVELOPMENT	75-1881060	875906MV8	06-27-2007	52,156,976	REFUNDING BONDS 2000 & 2005		X		X		X
B	BELL COUNTY HEALTH FACILITIES DEVELOPMENT CORP	74-2218760	078027HW2	06-27-2007	17,523,594	REFUNDING BONDS ISSUED 7/19/2000		X		X		X
C	TARRANT COUNTY HEALTH FACILITIES DEVELOPMENT	75-1881060	875906NY1	02-04-2010	231,948,097	DEVELOPMENT, CONSTR, EQUIPMENT COS		X		X		X
D	TARRANT COUNTY CULTURAL EDUCATION FACILITIES FINAN	04-3833551	87638QJC4	08-01-2013	71,222,592	REFUNDING PORTION OF 2010 BOND SER		X		X		X
	TARRANT COUNTY CULTURAL EDUCATION FACILITIES FINAN	04-3833551	87638QKX6	02-28-2014	176,767,688	CONSTRUCTION AND EQUIPMENT COSTS		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . . .	0		0		70,110,000		0
2 Amount of bonds legally defeased . . . . . . . . . . .	0		0		0		0
3 Total proceeds of issue . . . . . . . . . . . . . .	52,156,976		17,523,594		232,805,916		71,222,592
4 Gross proceeds in reserve funds . . . . . . . . . . . .	0		0		0		0
5 Capitalized interest from proceeds . . . . . . . . . . .	0		0		0		0
6 Proceeds in refunding escrows . . . . . . . . . . . .	50,833,752		17,116,642		0		70,145,033
7 Issuance costs from proceeds . . . . . . . . . . . .	672,932		229,475		2,686,446		1,077,553
8 Credit enhancement from proceeds . . . . . . . . . . .	650,292		177,477		0		0
9 Working capital expenditures from proceeds . . . . . . . . .	0		0		0		0
10 Capital expenditures from proceeds . . . . . . . . . . .	0		0		230,119,470		0
11 Other spent proceeds . . . . . . . . . . . . . .	0		0		0		0
12 Other unspent proceeds . . . . . . . . . . . . . .	0		0		0		0
13 Year of substantial completion . . . . . . . . . . . .	2007		2007		2011		2013
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . . .	X			X		X	X
15 Were the bonds issued as part of an advance refunding issue? . . . . .		X	X			X		X
16 Has the final allocation of proceeds been made? . . . . . . . .	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . .	X		X		X		X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .		X		X	X			X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2013

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .		X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .		X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . .	0 %		0 %		0.260 %		0.080 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . .	0 %						0 %
6 Total of lines 4 and 5 . . . . . . . . . . . . .	0.260 %				0.260 %		0.080 %
7 Does the bond issue meet the private security or payment test? . . . . .	X				X		X
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of.
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .		X		X		X		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? . . . . . . .	X		X		X		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T? . . . . .		X		X		X		X
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .
b Exception to rebate? . . . . . . . .
c No rebate due? . . . . . . . .	X		X		X		X
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .		X		X	X			X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider . . . . . . . . .	0		0		0
c Term of hedge . . . . . . . . . .
d Was the hedge superintegrated? . . . .
e Was the hedge terminated? . . . . . .

Schedule K (Form 990) 2013

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .		X		X		X		X
b Name of provider . . . . . . . . .	0		0		0		0
c Term of GIC . . . . . . . . . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .	X		X		X		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part VI

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
PART II, COLUMN C, LINE 3	TOTAL PROCEEDS OF ISSUE TOTAL PROCEEDS INCLUDE INVESTMENT EARNINGS.
PART IV, COLUMN A & B, LINE 2C	NO REBATE DUE THE FINAL REBATE COMPUTATION WAS PERFORMED AS OF 6/27/2012.
PART IV, COLUMN C, LINE 2C	NO REBATE DUE THE FINAL REBATE COMPUTATION WAS PERFORMED AS OF 2/4/2014.
PART IV, COLUMN D, LINE 2C	NO REBATE DUE THE FINAL REBATE COMPUTATION WAS PERFORMED AS OF 2/4/2014.
PART III, LINE 7, COLUMNS C & D	FOR THE PURPOSES OF CALCULATING THE PRIVATE SECURITY OR PAYMENT TEST, COOK CHILDREN'S MEDICAL CENTER (CCMC) HAS INCLUDED GROSS RECEIPTS FROM CERTAIN ACTIVITIES THAT CCMC HAS CONCLUDED GENERATE PRIVATE PAYMENTS. CALCULATED IN THAT MANNER, CCMC HAS CONCLUDED THAT THE PRIVATE PAYMENT TEST HAS BEEN MET WITH RESPECT TO THE BOND ISSUES DESCRIBED IN COLUMNS C & D. HOWEVER, THE AMOUNT OF PRIVATE BUSINESS USE WITH RESPECT TO THE BOND ISSUES DESCRIBED IN COLUMNS C & D IS LESS THAN 5%, IN EACH CASE, SO THAT EACH OF THOSE BOND ISSUES FAILS THE PRIVATE BUSINESS USE TEST AND CONTINUES TO MEET THE REQUIREMENTS IMPOSED ON "QUALIFIED 501(C)(3) BONDS."
PART II, COLUMN A, LINE 3 (2014 ISSUE)	TOTAL PROCEEDS INCLUDE INVESTMENT EARNINGS.
PART IV, COLUMN A, LINE 2C (2014 ISSUE)	NO REBATE DUE THE REBATE COMPUTATION WAS PERFORMED AS OF 2/28/2015.

Schedule K (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization

Cook Children's Medical Center

Employer identification number

75-2051646

Return Reference	Explanation
FORM 990 PART VI, SECTION A, QUESTION 6	SOLE MEMBER: COOK CHILDREN'S HEALTH CARE SYSTEM, A TEXAS NON-PROFIT CORPORATION, IS THE SOLE MEMBER OF THE ORGANIZATION.
FORM 990 PART VI, SECTION A, QUESTION 7A	MEMBER ELECTION ABILITIES: AS THE SOLE MEMBER OF THE ORGANIZATION COOK CHILDREN'S HEALTH CARE SYSTEM HAS THE POWER TO DETERMINE THE NUMBER OF MEMBERS OF THE BOARD OF TRUSTEES AND TO ELECT THE MEMBERS OF THE BOARD OF TRUSTEES.
FORM 990 PART VI, SECTION A, QUESTION 7B	MEMBER DECISION ABILITIES: AS THE SOLE MEMBER OF THE ORGANIZATION, COOK CHILDREN'S HEALTH CARE SYSTEM HAS THE EXCLUSIVE POWER AND RESERVED POWER TO DO ANY OF THE FOLLOWING: A. AMEND, ALTER OR REPEAL THE BYLAWS; B. AMEND THE CERTIFICATE OF FORMATION OF THE ORGANIZATION; C. DETERMINE THE NUMBER OF MEMBERS OF THE BOARD OF TRUSTEES AND TO ELECT THE MEMBERS OF THE BOARD OF TRUSTEES; D. APPROVE ANY MERGER, ACQUISITION, LIQUIDATION, WINDING UP, TERMINATION OR CONSOLIDATION OF THE ORGANIZATION; E. APPROVE THE SALE, GIFT OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY OF THE ORGANIZATION; AND, F. APPROVE THE CREATION OF, OR INVESTMENT IN, ANY SUBSIDIARY ENTITY.
FORM 990 PART VI, SECTION B, QUESTION 11B	REVIEW PROCESS FOR FORM 990: THE ORGANIZATION ENGAGES AN OUTSIDE INDEPENDENT ACCOUNTING FIRM TO ASSIST IN THE PREPARATION OF THE FORM 990 AND RELATED FILINGS. ALL INFORMATION PROVIDED TO THE OUTSIDE ACCOUNTING FIRM IS GATHERED BY KEY COMPANY EMPLOYEES AND EXECUTIVES. ONCE THE FORM 990 IS PREPARED, IT IS REVIEWED BY COMPANY FINANCE, LEGAL AND COMPLIANCE STAFF AND THEN PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW AND COMMENT. IN ADDITION, IT IS PRESENTED TO THE COOK CHILDREN'S HEALTH CARE SYSTEM AUDIT COMMITTEE FOR REVIEW AND COMMENT. SUBSEQUENT TO AUDIT COMMITTEE REVIEW, THE FORM 990 IS FILED WITH THE INTERNAL REVENUE SERVICE AND MADE AVAILABLE TO THE PUBLIC FOR REVIEW.
FORM 990 PART VI, SECTION B, QUESTION 15A & 15B	REVIEW AND APPROVAL OF COMPENSATION: COOK CHILDREN'S HEALTH CARE SYSTEM HAS ESTABLISHED A COMPENSATION COMMITTEE WITH OVERSIGHT OF EXECUTIVE AND PHYSICIAN COMPENSATION, WHICH INCLUDES THE ORGANIZATION'S CEO AND OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION. THE COMPENSATION COMMITTEE APPROVES COMPENSATION ARRANGEMENTS IN ADVANCE, WHICH INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT COMMITTEE MEMBERS, USING COMPARABLE MARKET DATA RELATING TO COMPENSATION, WHICH IS PROVIDED BY SULLIVAN COTTER AND ASSOCIATES, INC., AN INDEPENDENT, NATIONALLY RECOGNIZED COMPENSATION CONSULTANT. THE COMPENSATION COMMITTEE DOCUMENTS THE BASIS FOR ITS DETERMINATIONS FOLLOWING CONTEMPORANEOUS SUBSTANTIATION OF THE COMPENSATION COMMITTEE'S DELIBERATIONS AND DECISIONS. THE COMPENSATION COMMITTEE REQUIRES THE COMPENSATION CONSULTANT TO UPDATE MARKET DATA PERIODICALLY, USUALLY EVERY TWO YEARS, WITH INTERIM REVIEWS BEING CONDUCTED AS NEEDED. WITH REGARD TO PHYSICIAN COMPENSATION, THE COMPENSATION COMMITTEE ALSO RETAINS THE LAW FIRM OF MCDERMOTT, WILL & EMERY OF CHICAGO, ILLINOIS, TO ISSUE A REASONABLENESS OPINION COVERING THE PHYSICIAN COMPENSATION PLAN FOR COOK CHILDREN'S PHYSICIAN NETWORK.
FORM 990 PART VI, SECTION C, QUESTION 19	PROCESS OF MAKING GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC: THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC, EXCEPT TO THE EXTENT THEY ARE ON FILE WITH THE SECRETARY OF STATE OF TEXAS. THE CONFLICT OF INTEREST POLICY IS POSTED ON THE ORGANIZATION'S INTERNAL WEBSITE AND AVAILABLE TO ALL EMPLOYEES AND BOARD MEMBERS OF COOK CHILDREN'S HEALTH CARE SYSTEM ENTITIES. CONSOLIDATED FINANCIAL STATEMENTS ARE REPORTED ELECTRONICALLY FOR ALL COOK CHILDREN'S HEALTH CARE SYSTEM ENTITIES VIA THE ELECTRONIC MUNICIPAL MARKET ACCESS ("EMMA") WEB SITE.
FORM 990 PART VI, SECTION B, QUESTION 12C	WRITTEN CONFLICT OF INTEREST POLICY: EVERY YEAR THE LEGAL DEPARTMENT OF THE COOK CHILDREN'S HEALTH CARE SYSTEM ("SYSTEM") SENDS OUT A FORM 990 QUESTIONNAIRE/CONFLICT OF INTEREST DISCLOSURE STATEMENT TO OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES OF ALL SYSTEM COMPANIES, AS WELL AS CERTAIN OTHER EMPLOYEES, INCLUDING PHYSICIANS, WHO ARE DETERMINED TO BE EMPLOYED IN POSITIONS THAT MIGHT BE SUBJECT TO THE SYSTEM'S CONFLICT OF INTEREST POLICY. THE RESPONSES ARE REVIEWED BY THE LEGAL, FINANCE, AND COMPLIANCE DEPARTMENTS. FOLLOW UP AND/OR CORRECTIVE ACTION IS TAKEN AS NEEDED WITH RESPECT TO RESPONSES THAT INDICATE THE EXISTENCE OF ACTUAL OR POTENTIAL CONFLICTS OF INTEREST. THE RESPONSES TO THE QUESTIONNAIRES AND FOLLOW-UP INFORMATION ARE PROVIDED TO THE SYSTEM AUDIT COMMITTEE FOR REVIEW AND FOLLOW-UP. FURTHER, THE AUDIT COMMITTEE OF COOK CHILDREN'S HEALTH CARE SYSTEM IS RESPONSIBLE FOR MONITORING THE IMPLEMENTATION AND ENFORCEMENT OF THE CONFLICT OF INTEREST POLICY THAT IS APPLICABLE TO ALL AFFILIATED COMPANIES OF THE COOK CHILDREN'S HEALTH CARE SYSTEM. THE AUDIT COMMITTEE IS ALSO RESPONSIBLE FOR OVERSIGHT OF THE COMPLIANCE DEPARTMENT OF COOK CHILDREN'S HEALTH CARE SYSTEM. THE COMPLIANCE DEPARTMENT MAINTAINS A HOT-LINE TO RECEIVE REPORTS OF INAPPROPRIATE ACTIVITIES INCLUDING ACTIVITIES THAT MIGHT CONSTITUTE A CONFLICT OF INTEREST. INTERNAL AUDIT AND COMPLIANCE ALSO CONDUCT RANDOM AUDITS OF CORPORATE ACTIVITIES SUCH AS EXPENSE REIMBURSEMENTS AND ACCOUNTS PAYABLE TO DETERMINE IF ANY INAPPROPRIATE PAYMENTS ARE BEING MADE TO INDIVIDUALS, SOME OF WHICH COULD BE EVIDENCE OF A CONFLICT OF INTEREST. ANY CORRECTIVE ACTION RELATED TO CONFLICTS OF INTEREST WOULD BE REPORTED TO THE AUDIT COMMITTEE FOR REVIEW, APPROVAL, AND MODIFICATION, AS NECESSARY, WITH FURTHER REPORTING TO THE SYSTEM BOARD OF TRUSTEES AS APPROPRIATE.
FORM 990 PART VI, SECTION A, QUESTION 3	A MANAGEMENT COMPANY MANAGES THE DAY TO DAY OPERATIONS OF BOTH OF OUR JOINT VENTURES.
FORM 990 PART XI, LINE 9	OTHER CHANGES IN NET ASSETS OR FUND BALANCES: TRANSFERS BETWEEN AFFILIATES ($ 7,545,493) INTEREST RATE SWAP ADJUSTMENT 715,896 --------------- TOTAL ($ 6,829,597)

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

Cook Children's Medical Center

Employer identification number

75-2051646

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) COOK CHILDREN'S PHYSICIAN NETWORK 801 SEVENTH AVE FORT WORTH,TX76104 75-2485366	PHYSICIAN SVC	TX	501(C)(3)	3	CCHCS		No
(2) WI COOK FOUNDATION 801 SEVENTH AVE FORT WORTH,TX76104 75-2056149	FUNDRAISING	TX	501(C)(3)	11D	NA		No
(3) COOK CHILDREN'S HOME HEALTH 801 SEVENTH AVE FT WORTH,TX76104 75-2896983	HEALTHCARE	TX	501(C)(3)	9	CCHCS		No
(4) COOK CHILDREN'S HEALTH CARE SYSTEM 801 SEVENTH AVE FORT WORTH,TX76104 75-2705881	HLTH CARE SUP	TX	501(C)(3)	11C	CCHF		No
(5) COOK CHILDREN'S HEALTH PLAN 801 SEVENTH AVE FORT WORTH,TX76104 76-0585240	INSURANCE	TX	501(C)(3)	9	CCHCS		No
(6) ROSEDALE OFFICE BUILDING INC 1500 W ROSEDALE FORT WORTH,TX76104 46-0866421	TITLE HOLDING	TX	501(C)(2)	N/A	CCHF		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2013

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) COOK CHILDREN'S NORTHEAST HOSPITAL 801 SEVENTH AVE FORT WORTH,TX76104 20-5227064	HOSPITAL	TX	NA	RELATED	3,836,523	5,722,948		No	0	Yes		56.354 %
(2) CENTER FOR PEDIATRIC SURGERY 801 SEVENTH AVE FORT WORTH,TX76104 47-0871715	ASC	TX	NA	RELATED	6,759,016	12,627,089		No	0		No	52.319 %
(3) CPS PEDIATRICS LLC 11221 ROE AVE SUITE 320 LEAWOOD,KS66211 47-0871718	ASC	TX	NA	RELATED	34,512	103,336		No	0	Yes		52.646 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) COOK CHILDREN'S HEALTH SERVICES INC 801 7TH AVENUE FORT WORTH,TX76104 45-4024843	HEALTHCARE	TX	CCHCS	C CORPORATION				No

Schedule R (Form 990) 2013

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

Yes

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) COOK CHILDREN'S NORTHEAST HOSPITAL LLC	S	4,295,004	FMV
(2) CENTER FOR PEDIATRIC SURGERY LTD	S	7,528,728	FMV

Schedule R (Form 990) 2013

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V?UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V?UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2013

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2013

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: KNOWING THAT EVERY CHILD'S LIFE IS SACRED, IT IS THE PROMISE OF COOK OUR PROMISE IS TO IMPROVE THE HEALTH OF EVERY CHILD IN OUR REGION THROUGH THE PREVENTION AND TREATMENT OF ILLNESS, DISEASE AND INJURY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	13
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	13
5	Total number of individuals employed in calendar year 2013 (Part V, line 2a) ......	5	4,530
6	Total number of volunteers (estimate if necessary) .............	6	1,467
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	138,077
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	104,304

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	11,605,462	11,021,381
9	Program service revenue (Part VIII, line 2g) .........	812,298,871	842,058,390
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	542,569	384,343
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	3,739,334	2,845,462
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	828,186,236	856,309,576
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	47,236,427	51,133,835
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	289,635,935	298,199,145
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	330,831,092	326,406,844
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	667,703,454	675,739,824
19	Revenue less expenses. Subtract line 18 from line 12.......	160,482,782	180,569,752
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	854,499,605	1,217,738,885
21	Total liabilities (Part X, line 26).............	383,129,428	558,969,359
22	Net assets or fund balances. Subtract line 21 from line 20.....	471,370,177	658,769,526

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 498,454,255 including grants of $ 51,133,835 ) (Revenue $ 843,671,102 )
	COOK CHILDREN'S MEDICAL CENTER HAS NATIONALLY RESPECTED NURSING STAFF WITH MAGNET DESIGNATION BY THE AMERICAN NURSES CREDENTIALING CENTER SINCE 2006 AND RE-DESIGNATED IN 2011. THIS RECOGNITION OF QUALITY PATIENT CARE AND NURSING EXCELLENCE HAS BEEN ACHIEVED BY 7 PERCENT OF ALL HEALTHCARE ORGANIZATIONS NATIONWIDE. COOK CHILDREN'S IS KNOWN FOR ITS NURSING EXCELLENCE AND HAS A DISTINGUISHED INTERNATIONAL REPUTATION FOR PROVIDING EXTRAORDINARY CARE AND ACHIEVING POSITIVE OUTCOMES IN ITS NEUROLOGY, NEUROSURGERY, CARDIOLOGY, CARDIOTHORACIC SURGERY, HEMATOLOGY AND ONCOLOGY, NEONATOLOGY AND PULMONOLOGY PROGRAMS. THE MEDICAL CENTER ACCOUNTED FOR 84 PERCENT OF TARRANT COUNTY'S PEDIATRIC ADMISSIONS IN 2014. WITH THE CULMINATION OF A HISTORIC BUILDING INITIATIVE THAT BEGAN IN 2009, THE MEDICAL CENTER IS NOW LICENSED FOR 430 BEDS, MAKING IT ONE OF THE LARGEST CHILDREN'S HOSPITALS IN THE COUNTRY. THE 530,000 SQUARE FOOT EXPANSION INCLUDES A LEVEL IV NICU, MORE ROOMS IN THE HEMATOLOGY AND ONCOLOGY UNIT AND THE TRANSITIONAL CARE AND REHABILITATION CARE UNITS, TWO NEW HELIPADS, A FOOD COURT, A PATIENT LIBRARY WITH CLASSROOMS, A PATIENT BUSINESS CENTER, AN INDOOR/OUTDOOR PLAYGROUND AND 1,300 ADDITIONAL PARKING SPACES. THE DODSON SPECIALTY CLINICS BUILDING HOUSES 18 PEDIATRIC SUBSPECIALTY CLINICS, INCLUDING THE SURGERY CENTER, A CANCER CENTER, HEART CENTER AND NEUROSCIENCES. THE DODSON SURGERY CENTER OPENED IN MARCH 2012 AND SERVES PEDIATRIC PATIENTS NEEDING OUTPATIENT PROCEDURES SUCH AS TREATING ISSUES WITH EYES, EAR/NOSE/THROAT, MINOR ORTHOPEDICS AND GENERAL SURGERY. IT INCLUDES: - SIX ACUTE BEDS AND 22 PREP/RECOVERY BEDS. - SIX STATE OF THE ART OPERATING SUITES FOR OUTPATIENT PROCEDURES, INCLUDING TWO EYE SURGERY SUITES. - COMPLIMENTARY VALET PARKING ON THE DAY OF SURGERY FOR THE FAMILIES. IN ADDITION TO THE DODSON SURGERY CENTER, THE LOWER LEVEL HOUSES RADIOLOGY OUTPATIENT SERVICES AND THE MAGNETOENCEPHALOGRAPHY (MEG); BOTH ARE NONINVASIVE, ADVANCED IMAGING TECHNOLOGIES. THE MEG, COUPLED WITH COOK CHILDREN'S MRI AND IMRI TECHNOLOGY, KEEPS THE MEDICAL CENTER AT THE FOREFRONT AMONG THE NATION'S BEST STATE-OF-THE-ART FACILITIES. - THE FIRST LEVEL OF THE BUILDING IS THE ENTRY POINT FOR ALL CLINICAL SERVICES. IT INCLUDES CENTRALIZED REGISTRATION/CHECK-IN, DIALYSIS, INFECTIOUS DISEASE, NEPHROLOGY, ORTHOPEDICS AND OUTPATIENT LAB SERVICES. - THE SECOND LEVEL PROVIDES CLINIC SPACE FOR PATIENTS NEEDING ENDOCRINOLOGY, GASTROENTEROLOGY AND PULMONOLOGY SERVICES. - THE THIRD LEVEL IS THE HOME TO COOK CHILDREN'S HEART CENTER WHICH INCLUDES CLINICS, DIAGNOSTICS AND OFFICE SPACE. PEDIATRIC SURGERY AND NICU OFFICES ARE ON THE THIRD FLOOR AS WELL TO TAKE ADVANTAGE OF THE DIRECT CONNECTION TO THE NEW NICU SPACE ON LEVEL 3 OF THE NORTH TOWER. - THE FOURTH LEVEL IS PART OF THE JANE AND JOHN JUSTIN NEUROSCIENCES CENTER AND INCLUDES CLINICS, DIAGNOSTICS AND OFFICE SPACE FOR NEUROLOGY, NEUROSURGERY, PAIN MANAGEMENT, CRANIOFACIAL AND CLEFT SURGERY, RHEUMATOLOGY, PALLIATIVE CARE AND NEUROPSYCHOLOGY. - THE NEURODIAGNOSTICS CENTER HAS A DUAL FUNCTION AS A SLEEP STUDY CENTER AND A DIRECT CONNECTION TO TRANSITIONAL CARE UNIT AND REHABILITATION CARE UNIT BEDS IN THE NORTH TOWER AND NORTH PAVILION. - THE FIFTH LEVEL IS THE CANCER CENTER. IT INCLUDES: - AN EXPANDED INFUSION AREA, DEDICATED LABORATORY AND DEDICATED, FULL-TIME PHARMACY. - ACCESS TO HEMATOLOGY AND ONCOLOGY INPATIENT BEDS THROUGH A DIRECT CONNECTION TO THE NORTH TOWER. - NEW, PRIVATE FAMILY SPACES FOR NEEDED BREAKS. - NEW MEDITATIVE GARDEN AND FAMILY SUITE FOR PALLIATIVE CARE PATIENTS. - DEDICATED OFFICES AND SPACE TO PROMOTE COLLABORATIVE CARE AND COMPREHENSIVE CARE. - A TELEMEDICINE ROOM FOR CONSULTATIONS. - STATE-OF-THE-ART WIRELESS NETWORKING INFRASTRUCTURE. COOK CHILDREN'S IS THE ONLY PEDIATRIC FACILITY IN THE SOUTHWEST TO OFFER I-131 METAIODOBENZYLGUANIDINE (MIBG) THERAPY. THIS EXPANSION HAS POSITIONED COOK CHILDREN'S TO CONTINUE TO PROVIDE THE OUTSTANDING QUALITY THAT IS THE CORNERSTONE OF ITS CARE, IN RESPONSE TO THE CHALLENGES OF AN EVERGROWING POPULATION. IN ADDITION, COOK CHILDREN'S MEDICAL CENTER WAS SELECTED AS A LEAPFROG TOP CHILDREN'S HOSPITAL. THIS DISTINCTION IS ONLY ACHIEVED BY AN ELITE GROUP OF HOSPITALS THAT MEET THE NATION'S TOUGHEST STANDARDS FOR SAFETY AND QUALITY. AS PART OF THIS DISTINCTION, COOK CHILDREN'S WAS RECOGNIZED FOR THE IMPLEMENTATION OF COMPUTERIZED PROVIDER ORDER ENTRY (CPOE) AND BAR CODED MEDICATION ADMINISTRATION. THE MEDICAL CENTER OFFERS ADVANCED TECHNOLOGICAL EQUIPMENT, LEADING SURGICAL TECHNIQUES, REHABILITATION FACILITIES AND ANCILLARY SERVICES DESIGNED TO MEET THE SPECIAL NEEDS OF CHILDREN. ADDITIONALLY, THE CAMPUS BOASTS A PROFESSIONAL AND HIGHLY SKILLED STAFF OF NURSES, TECHNOLOGISTS, THERAPISTS AND OTHER CLINICIANS, AS WELL AS MORE THAN 600 PHYSICIANS AND DENTISTS WHO PROVIDE PRIMARY, SECONDARY, TERTIARY AND QUATERNARY LEVELS OF PEDIATRIC CARE. CHILD LIFE SPECIALISTS, CHAPLAINS, TEACHERS, SOCIAL SERVICES COORDINATORS AND TRANSLATORS HELP PATIENTS AND FAMILIES COPE WITH THE STRESSES THAT ACCOMPANY A CHILD'S HOSPITALIZATION. THE MEDICAL CENTER IS HOME TO THE ONLY EMS-DESIGNATED, LEVEL II PEDIATRIC TRAUMA CENTER IN TARRANT COUNTY, TEXAS. IN 2012, 127,941 PATIENTS WERE TREATED IN THE EMERGENCY DEPARTMENT AND URGENT CARE CENTER AT COOK CHILDREN'S. THE AWARD-WINNING COOK CHILDREN'S MEDICAL CENTER IS SUPPORTED BY ONE OF THE BUSIEST NEONATAL/PEDIATRIC TRANSPORT PROGRAMS IN THE NATION, TEDDY BEAR TRANSPORT, WHICH BRINGS MORE THAN 3,000 CHILDREN TO THE MEDICAL CENTER ANNUALLY FOR A HIGHER LEVEL OF CARE. SERVICES INCLUDE AMBULANCE, HELICOPTER AND FIXED-WING AIRPLANE TRANSPORTATION. COOK CHILDREN'S TEDDY BEAR TRANSPORT STAFF OF 52 NEONATAL/PEDIATRIC NURSES, RESPIRATORY THERAPISTS AND PARAMEDICS IS PROUD TO HAVE MORE THAN 400 COMBINED YEARS OF TRANSPORT EXPERIENCE. THIS TEAM IS DEDICATED TO GETTING THE MOST MEDICALLY FRAGILE CHILDREN AND NEONATES TO OUR AWARD-WINNING MEDICAL CENTER QUICKLY AND SAFELY. OUR TEAM OF HIGHLY SPECIALIZED NURSES, RESPIRATORY THERAPISTS AND PARAMEDICS BEGIN GIVING CARE TO PATIENTS IMMEDIATELY UPON ARRIVAL TO THEIR LOCATION. ONCE THEY ARRIVE AT COOK CHILDREN'S MEDICAL CENTER, PATIENTS ARE TREATED BY OUR BOARD CERTIFIED PHYSICIANS AND NATIONALLY RECOGNIZED NURSING STAFF. COOK CHILDREN'S IS THE ONLY LEVEL IV NICU IN TARRANT COUNTY, THE HIGHEST QUALIFICATION FOR SUCH PROGRAMS AS ESTABLISHED BY THE AMERICAN ACADEMY OF PEDIATRICS. LEVEL IV NICUS MAINTAIN A FULL RANGE OF PEDIATRIC MEDICAL AND SURGICAL SUBSPECIALISTS AND PEDIATRIC ANESTHESIOLOGISTS ON-SITE. THE TWO-LEVEL, ALL-SINGLE-ROOM ENVIRONMENT IS STAFFED WITH A TEAM OF NEONATOLOGISTS AND SPECIALISTS WHO COMBINE EXPERTISE WITH THE LATEST TECHNOLOGY TO PROVIDE THE HIGHEST LEVEL OF NEONATAL CARE AVAILABLE. STUDIES SHOW THAT PREMATURE AND CRITICALLY ILL INFANTS WHO ARE CARED FOR IN A SINGLE ROOM SETTING HAVE BETTER LONG-TERM OUTCOMES. THESE TINY PATIENTS ARE SHOWN TO GROW BETTER, GET MORE OXYGEN, AND GO HOME QUICKER. COOK CHILDREN'S ALL-SINGLE ROOM NICU WAS THE LARGEST IN THE NATION AT THE TIME OF COMPLETION, AND ONE OF THE FEW THAT CAN ACCOMMODATE TWINS, TRIPLETS AND EVEN QUADS IN A SINGLE ROOM. COOK CHILDREN'S DESIGNATED LEVEL II TRAUMA CENTER IS STAFFED AND EQUIPPED TO PROVIDE COMPREHENSIVE EMERGENCY MEDICAL SERVICES TO PATIENTS SUFFERING TRAUMATIC INJURIES 24 HOURS A DAY, 7 DAYS A WEEK. COOK CHILDREN'S OPENED THE CHILD LIFE ZONE IN THE MEDICAL CENTER ON MAY 15, 2012. COUNTRY MUSIC LEGEND GARTH BROOKS AND FORMER DALLAS COWBOYS QUARTERBACK AND NFL HALL OF FAMER TROY AIKMAN WERE ON HAND TO HELP WITH THE CELEBRATION. THEY REPRESENTED THE GARTH BROOKS/TROY AIKMAN TEAMMATES FOR KIDS FOUNDATION THAT WAS A DRIVING FORCE BEHIND THE PROJECT. THE NEW AREA WITHIN COOK CHILDREN'S MEDICAL CENTER WAS DESIGNED TO BE A PLACE WHERE KIDS CAN HAVE FUN, HANG OUT WITH EACH OTHER AND FORGET ABOUT BEING PATIENTS FOR A WHILE. TEENS FROM THE YOUTH ADVISORY COUNCIL- PATIENTS ADVOCATING FOR CHANGE (YAC-PAC) WERE INSTRUMENTAL IN HELPING TO DESIGN THE SPACE. THE 4,000-SQUARE-FOOT ADDITION HOUSES A TEENS-ONLY ROOM WITH ARCADE GAMES, POOL AND FOOSBALL TABLES, A JUKE BOX, SEVERAL GAMING SYSTEMS AND MORE. IN ADDITION, THE CHILD LIFE ZONE ALSO CONSISTS OF THE MATUSTIK FAMILY RESOURCE CENTER, BOMAR LIBRARY, COMPUTERS FOR PARENTS AND FAMILIES AND RAY'S PLACE SNACK BAR. HOWEVER, THE MAIN ATTRACTION IS THE RECORDING AND BROADCAST STUDIO, OFFERING THE MOST CONTEMPORARY TECHNOLOGY, WHERE PATIENTS CAN EXPERIENCE HEALING AND ESCAPE THROUGH MUSIC AND VIDEO CREATION.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses498,454,255

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)		(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(1) JAMES F HERD SR MD........................................................................ TRUSTEE	1.0 .......................1.0	X
(2) MARSHA HILCHER........................................................................ TRUSTEE-CHAIRMAN	2.0 .......................1.0	X	X
(3) CHRISTOPHER M HUCKABEE........................................................................ TRUSTEE	1.0 .......................1.0	X
(4) WM MACK LAWHON........................................................................ TRUSTEE	1.0 .......................1.0	X
(5) ROGER NOBER........................................................................ TRUSTEE	1.0 .......................0.0	X
(6) BONNIE PETSCHE........................................................................ TRUSTEE	1.0 .......................1.0	X
(7) PETER L PHILPOTT........................................................................ TRUSTEE	1.0 .......................4.0	X
(8) JERRY R CONATSER........................................................................ TRUSTEE-SECRETARY/TREASURER	2.0 .......................1.0	X	X
(9) JOHN P BOSWELL........................................................................ TRUSTEE/VICE-CHAIRMAN	2.0 .......................4.0	X	X
(10) SHARON S MAYES........................................................................ TRUSTEE	1.0 .......................0.0	X
(11) DANA C KELLY........................................................................ TRUSTEE	1.0 .......................1.0	X
(12) MICHELLE M MARLOW........................................................................ TRUSTEE	1.0 .......................0.0	X
(13) JEFF CONNOR........................................................................ TRUSTEE	1.0 .......................0.0	X
(14) GARY G WALSH........................................................................ TRUSTEE	1.0 .......................0.0	X
(15) NANCY C CYCHOL........................................................................ PRESIDENT	40.0 .......................0.0		X	703,378		28,533
(16) STANLEY E DAVIS........................................................................ VP, SUPPORT SERVICES	40.0 .......................0.0		X	251,806		27,676
(17) RICHARD P GOODE........................................................................ CHIEF FINANCIAL OFFICER	22.0 .......................18.0		X	367,824	300,947	29,091

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) CARA MARTZ........................................................................ SECRETARY	1.0 .......................39.0	X			111,349	8,771
(19) RICK W MERRILL........................................................................ CHIEF EXECUTIVE OFFICER	12.0 .......................28.0	X		401,414	936,632	190,582
(20) GEORGE B MONTAGUE........................................................................ VP, REAL ESTATE	2.0 .......................38.0	X			307,293	31,571
(21) PAULA J WEBB........................................................................ VP, NURSING	40.0 .......................0.0	X		307,027		22,575
(22) TARESA J CLARK........................................................................ VP, NURSING/CNO	40.0 .......................0.0	X		248,230		22,917
(23) JACK SOSEBEE........................................................................ VP, FAMILY SUPPORT SVCS	40.0 .......................0.0	X		183,124		23,696
(24) STEPHEN W KIMMEL........................................................................ CHIEF FINANCIAL OFFICER	22.0 .......................18.0	X
(25) BRADLEY HORN........................................................................ PHARMACIST	40.0 .......................0.0		X	191,864		22,036
(26) ROSANNE THURMAN........................................................................ DIRECTOR, PHARMACY	40.0 .......................0.0		X	178,448		19,481
(27) KEVIN L DAHLE........................................................................ PHARMACIST	40.0 .......................0.0		X	177,278		23,225
(28) KIMBERLY JONES........................................................................ AVP-PERIOPERATIVE SVCS	40.0 .......................0.0		X	276,125		27,516
(29) SHARON SMITH........................................................................ DIRECTOR-AMBULATORY SURG SVCS	40.0 .......................0.0		X	201,009		9,405

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	3,487,527	1,656,221	487,075

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		9,688,533
e	Government grants (contributions)1e		310,183

f	All other contributions, gifts, grants, and similar amounts not included above1f		1,022,665

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			11,021,381
			Business Code
2a	PATIENT SERVICES		621110	775,709,383	775,709,383
b	OTHER OPERATING REVENUE		621110	55,157,489	55,157,489
c	JOINT VENTURE REVENUE		621110	11,053,441	11,053,441
d	LAB REFERRALS		621500	138,077		138,077
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			842,058,390
3	Investment income (including dividends, interest, and other similar amounts).......			237,294			237,294
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties...........			0
		(i) Real	(ii) Personal
6a	Gross rents	2,884,295
b	Less: rental expenses	1,651,545
c	Rental income or (loss)	1,232,750	0
d	Net rental income or (loss).......			1,232,750			1,232,750
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory		197,049
b	Less: cost or other basis and sales expenses		50,000
c	Gain or (loss)		147,049
d	Net gain or (loss)..........			147,049			147,049
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ..
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...			0
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			0
Miscellaneous Revenue			Business Code
11a	CCIC RETRO PREMIUM		900099	1,612,712	1,612,712
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			1,612,712
12	Total revenue. See Instructions......			856,309,576	843,533,025	138,077	1,617,093


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............			12,260	1	12,995
2	Savings and temporary cash investments .........			269,263,512	2	373,121,277
3	Pledges and grants receivable, net ...........			0	3	0
4	Accounts receivable, net .............			74,744,066	4	80,026,528
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
				0	6	0
7	Notes and loans receivable, net .............			18,870,960	7	24,219,660
8	Inventories for sale or use ..............			6,927,758	8	7,588,405
9	Prepaid expenses and deferred charges ..........			838,931	9	272,583
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	788,518,922
b	Less: accumulated depreciation .....	10b	289,577,801	436,783,028	10c	498,941,121
11	Investments—publicly traded securities ..........			8,009,418	11	182,340,486
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 .....			0	13	0
14	Intangible assets ...............			7,424,990	14	7,424,990
15	Other assets. See Part IV, line 11 ...........			31,624,682	15	43,790,840
16	Total assets. Add lines 1 through 15 (must equal line 34)......			854,499,605	16	1,217,738,885
17	Accounts payable and accrued expenses .........			63,700,555	17	86,961,995
18	Grants payable .................			0	18	0
19	Deferred revenue ................			6,832	19	15,982
20	Tax-exempt bond liabilities .............			295,407,851	20	467,295,766
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			0	21	0
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........			0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..			0	23	0
24	Unsecured notes and loans payable to unrelated third parties ....			0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................			24,014,190	25	4,695,616
26	Total liabilities. Add lines 17 through 25.........			383,129,428	26	558,969,359
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			471,370,177	27	658,769,526
28	Temporarily restricted net assets ...........			0	28	0
29	Permanently restricted net assets ...........			0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances ...........			471,370,177	33	658,769,526
34	Total liabilities and net assets/fund balances ........			854,499,605	34	1,217,738,885